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Forest Service Roads <br />Inspection Form <br />Date: 51,,z ? /rg <br />Time: J: q5' -?M <br />r _ <br />Name of Inspector: tq (KE <br />Current Panel and XC Being Mined: 7 HG � XC 103 <br />Road(s) Being Inspected: "::t ^r <br />Yes No <br />l] [ Is the Forest Service road within the projected angle of draw of <br />subsidence? If yes, which road(s): <br />❑ [IL- Are there visible surface cracks on the road? If yes, describe <br />(location, width, length, etc.): <br />❑ 0' Is there any recent evidence of potential subsidence induced slope <br />failure? If yes, describe: <br />❑ B- Are there any other potentially damaging, subsidence induced <br />features on or near the road? If yes, describe: <br />❑ [�'� Is mitigation needed? If yes, list suggestions: <br />Notes: <br />Signature of Inspector: <br />* If any potential subsidence induced features are observed that could cause harm <br />to the public or operations, notify Mike Peacock or Kathy Welt immediately. <br />W:\A4CC-Engineering\ENV PERMITTING\REG AGENCIESTDRMSUnspection-Survey USFS Ponds & Rds\Roads\forest service roads inspection form <br />